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MODERN ASPECTS OF DIAGNOSIS IN PREMATURE AMNIOTIC FLUID
RETENTION
Gaybullayeva Lobar Sagdullaevna
Davronova Mahliyo Alisherovna
Scientific supervisor: Professor
Negmadjanov B.B.
Department of Obstetrics and Gynecology №2, Samarkand State Medical University,
Samarkand, Uzbekistan
https://doi.org/10.5281/zenodo.14715746
Annotation.
Premature amniotic fluid retention (PAFR) remains one of the most urgent
problems of modern obstetrics, as it significantly increases the risk of complications in labor.
In this work we studied the pathogenesis of uterine contractile initiation disorders in PIUI,
taking into account the peculiarities of steroid hormone metabolism and fetal hormonal
status. We examined 193 patients divided into a control group, a main group (with PAFR) and
a comparison group (with timely amniotic fluid shedding). It was found that PIOB is
accompanied
by
hyperprogesteronemia,
decreased
concentration
of
cortisol,
dehydroepiandrosterone-sulphate (DEAS) and estradiol, and insufficient oxytotic activity.
These findings indicate that the biological readiness of the fetus for labor is impaired,
necessitating the use of synthetic anti-gestagens and oxytocin to stimulate labor activity.
Keywords:
premature amniotic fluid retention, pathogenesis, steroid hormones,
cortisol, progesterone, estradiol, dehydroepiandrosterone sulfate (DEAS), oxytocin, induction
of labor, uterine contractility.
Relevance.
One of the topical and debated issues in modern obstetrics is the
management of labor in premature amniotic fluid loss (PAFL). The incidence of bladder
rupture before the onset of labor in preterm pregnancies varies from 10% to 19.8%, and this
figure has increased 1.5-2 times in recent decades.
The relevance of the topic of diagnosing premature retention of amniotic fluid
(polydamnia) can be substantiated by various scientific data and studies that emphasize the
importance of timely diagnosis and understanding of this condition. Here are some aspects
confirming the relevance:
Polydamnion occurs in 1%-2% of all pregnancies, but its incidence is significantly
increased in certain risk groups (for example, multiple pregnancies and diabetes). This
emphasizes the need for early diagnosis.
According to the Centers for Disease Control and Prevention (CDC), half of all cases of
polydamnion are associated with diabetes, making screening important for subgroups of
women.
Research shows that polydamnion is associated with an increased risk of complications
such as preterm labor, rupture of membranes, and fetal malposition. According to numerous
studies, polydamnion may increase the risk of perinatal mortality by 30%-40%.
A study published in the American Journal of Obstetrics and Gynecology found that high
amniotic fluid levels predicted the development of conditions such as premature placental
abruption and respiratory distress syndrome in the newborn.
Premature amniotic fluid discharge may increase maternal complications (such as
preeclampsia), which also highlights the need for monitoring of the mother and fetus.
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The study results show that women with polydamnion are more likely to have a
cesarean section, which will require more careful diagnosis and management.
Modern technologies, such as high-quality ultrasound scanning and fetal monitoring
methods, can improve the accuracy of polydamnion diagnosis and closely monitor the fetus.
Research conducted in the Journal of Ultrasound in Medicine shows that the use of new
imaging techniques improves prediction and diagnosis, helping physicians respond to
potential risks.
Awareness of polydamnion and its complications can affect the psycho-emotional state
of mothers. The stress and anxiety associated with abnormal amniotic fluid levels highlight
the importance of maternity care professionals.
Research shows that educating mothers about the risks is associated with improved
pregnancy outcomes.
The diagnosis of premature amniotic fluid retention is an important task in modern
obstetrics, associated with a high risk of complications for both mother and fetus. Scientific
data on the frequency of cases associated with serious complications, as well as
improvements in diagnostic technologies, confirm the need for in-depth assessment of this
topic. It is important to continue research in this area to improve practice and reduce risks.
Purpose of the study
– the study of pathogenetic mechanisms of impaired initiation of
uterine contractile activity in PAFL with emphasis on the peculiarities of steroid hormone
metabolism and changes in the hormonal status of the fetus.
Materials and methods.
To achieve this goal, a comprehensive examination of 193
women treated in the maternity department of the perinatal center of Samarkand City was
carried out. The study included: the control group (45 patients with physiological preterm
pregnancy), the main group (106 women in labor with PAFL), and the comparison group (42
women with timely amniotic fluid retention - TAFR).
Results of the study.
Progesterone concentration in venous blood was elevated in
patients with PAFL.
- Serum cortisol levels from the maternal ulnar vein and the umbilical artery and vein
were lower in PAFL compared with TAFR.
- Estradiol concentration remained minimal in women from the main and control
groups.
- Dehydroepiandrosterone-sulfate (DEAS) levels were statistically lower with TAFL than
with TAFR.
- The lowest oxytocin concentrations were observed in patients who underwent
cesarean section for TAFR.
Conclusions.
Premature amniotic fluid shedding is accompanied by a lack of biological
readiness of the fetus for labor, which is expressed by hyperprogesteronemia, and decreased
levels of cortisol, DEAS, and estradiol. Corticosteroid deficiency prevents adequate activation
of the mechanisms responsible for the initiation of uterine contractile activity.
The increased concentration of progesterone in the blood of patients with PAFL
confirms the pathogenetic feasibility of using synthetic anti-gestagens for induction of labor.
Decreased blood oxytocin levels and insufficient oxytocin activity of amniotic fluid in
PAFL explain the need to use oxytocin to induce labor.
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